Mental health services must be improved by expansion, better prevention, and integration with physical care.
These are the key findings of an NHS England taskforce, chaired by the Chief Executive of Mind Paul Farmer.
The taskforce suggests, and the NHS accepts, investing over £1bn a year of additional funding in NHS care by 2020/21 to reach one million more people – this investment is in addition to the previously announced new funding for children, young people and perinatal care.
On psychological therapies the report says only 15% of people who need it currently get care.
More action is also needed to help people with anxiety and depression to find or keep a job, as well as to ensure that people with long-term conditions have their physical and mental health care needs met.
By 2020, new funding should increase access to evidence-based psychological therapies to reach 25% of need, helping 600,000 more people access care.
Combined with investing to double the reach of Individual Placement and Support for people with severe mental illness, this should support a total of 29,000 more people to find or stay in work each year by 2020.
People with mental health problems receive poorer physical health care, and those living with severe mental illness at risk of dying on average 15-20 years earlier than the general population.
By 2020, at least 280,000 more people living with severe mental health problems should have improved support for their physical health.
Between 2013/14 and 2014/15 the number of referrals to Child and Adolescent Mental Health Services increased five times faster than the growth of the workforce in these services.
The £1.4bn (over five years) committed for children and young people’s (CYP) mental health should be invested to ensure that by 2020 at least 70,000 more children and young people have access to high quality care, the taskforce says.
At present only half of the country offers a 24/7 community-based mental health crisis service.
New funding should be made available so by 2020/21 Crisis Resolution and Home Treatment Teams (CRHTTs) can offer intensive home treatment as an alternative to acute inpatient admission in each part of England.
Only a minority of A&E departments currently have 24/7 liaison mental health services, even though peak hours for people presenting to A&E with mental health crises are 11pm-7am.
New funding should ensure by 2020/21 no acute hospital is without all-age mental health liaison services in emergency departments and inpatient wards, and at least half of acute hospitals meet the ‘core 24’ service standard.
One in five mothers suffers from mental health problems during pregnancy or in the first year after childbirth. It costs around £8.1 billion for each annual birth cohort or almost £10,000 per birth. Yet fewer than 15% of areas have the necessary perinatal mental health services and more than 40% provide none at all.
New funding should be invested to support at least 30,000 more women each year to access evidence-based specialist mental health care in the perinatal period.
Suicide is rising after many years of decline. To reduce suicides by 10% by 2020 all areas should have multi-agency suicide prevention plans in place by 2017 that are reviewed annually.
The taskforce also calls for the practice of sending people out of area for acute inpatient care due to local acute bed pressures to be eliminated entirely by no later than 2020/21.
Mental health services reaction
Paul Farmer said: “This is a landmark moment for mental health care in this country, a once-in-a-generation opportunity to transform services and support for people with mental health problems. We are saying to the NHS, to government, to industry, to local leaders and to the public that mental health must be a priority for everyone in England.
“We need to prevent problems in the first place, and to respond to people’s mental health problems at the earliest possible opportunity. As part of this, the NHS can and should be a world leader in care which treats people’s minds and bodies equally well.
“This report is a feasible and affordable blueprint for how to significantly improve care for people with mental health problems. We have consulted with the experts – people with experience of mental health problems, professionals providing care and the public. It’s time to make positive change.”
The report states that enabling good mental health, and effectively responding to mental health problems when they arise, is dependent on a wide range of socio-economic factors.
Wider recommendations include greater public transparency through changes in how spend on NHS mental health care is tracked and reported so it is clear what is being spent in communities on which mental health conditions.
A government champion for equalities and health inequalities.
The creation of prevention plans in every community across England to help integrate public health, social care and housing and improve mental health outcomes, with mental health champions in each community.